Form Bmv 4321 – Fill Out and Use This PDF

Limited Liability

Member (owning 10% or more) (BCI&I Civilian background check required.)

FIRST NAME		MI	LAST NAME
HOME ADDRESS			SSN
CITY		STATE	ZIP CODE
Member (owning 10% or more) (BCI&I Civilian background check required.)
FIRST NAME		MI	LAST NAME
HOME ADDRESS			SSN
CITY		STATE	ZIP CODE
Member (owning 10% or more) (BCI&I Civilian background check required.)
FIRST NAME		MI	LAST NAME
HOME ADDRESS			SSN
CITY		STATE	ZIP CODE
Member (owning 10% or more) (BCI&I Civilian background check required.)
FIRST NAME		MI	LAST NAME
HOME ADDRESS			SSN
CITY		STATE	ZIP CODE

If a member is a corporation, please list; the corporation’s name, federal tax ID number, address and below list officer’s name, address and social security number of the applicant.

*Use only if Member is a corporation.

BUSINESS NAME	FEDERAL TAX ID OR EIN #
ADDRESS	CITY	STATE	ZIP CODE
FIRST NAME	MI	LAST NAME
HOME ADDRESS		SSN
CITY	STATE	ZIP CODE

Any additional officers, please list on a separate sheet of paper and attach to this application.

BMV 4321 2/13 [17601163] Page 3 of 8

Partnership

Partner (BCI&I Civilian background check required)

FIRST NAME	MI	LAST NAME
HOME ADDRESS		SSN
CITY	STATE	ZIP CODE
Partner (BCI&I Civilian background check required)
FIRST NAME	MI	LAST NAME
HOME ADDRESS		SSN
CITY	STATE	ZIP CODE

If a partner is a corporation, please list; the corporation’s name, federal tax ID number, address and below list officer’s name, address and social security number of the applicant.

*Use only if Member is a corporation.

BUSINESS NAME	FEDERAL TAX ID OR EIN #
ADDRESS	CITY	STATE	ZIP CODE
FIRST NAME	MI	LAST NAME
HOME ADDRESS		SSN
CITY	STATE	ZIP CODE

Any additional officers, please list on a separate sheet of paper and attach to this application.

Business Trust

Trustee (BCI&I Civilian background check required)

FIRST NAME	MI	LAST NAME
HOME ADDRESS		SSN
CITY	STATE	ZIP CODE
Trustee (BCI&I Civilian background check required)
FIRST NAME	MI	LAST NAME
HOME ADDRESS		SSN
CITY	STATE	ZIP CODE

BMV 4321 2/13 [17601163] Page 4 of 8

Yes No 6. Have you or any person listed as an owner, officer, member, trustee, partner, or director ever been convicted of a felony?

Yes No 7. Have you or any person listed as an owner, officer, member, trustee, partner, or director ever been convicted of an offense that was related to the selling of or dealing in motor vehicles?

*If answered “yes” to either question #6 or #7 above, please provide the following information: (1) The courts journal entry showing the final disposition of your conviction.

(2)The charge you were convicted of.

(3)Please attach a short summary explaining the charge you were convicted of.

Yes No 8. Have you or any person listed as an owner, officer, member, trustee, partner, or director ever had a civil judgment rendered against you / him / her that related to tampering with an odometer, rolling back an odometer, or failing to provide true and accurate odometer disclosure statements.

Yes No 9. Have you or any person listed as an owner, officer, member, trustee, partner, or director ever had a civil judgment rendered against you that resulted from a transaction of business as a motor vehicle dealer, and remains unsatisfied?

*If answered “yes” to either question #8 or #9 above, please provide the following information:

(1)The courts journal entry showing the final disposition of the judgment

(2)The court of jurisdiction that decided the civil judgment

(3)That court’s case number

(4)The date the civil judgment was issued

Yes No 10. Will any business other than a licensed motor vehicle dealer be operated from this proposed Dealership location?

This includes a business operating from the building your office is housed and / or any other building on the proposed motor vehicle dealership location. If yes what type of business is sharing the location (Include business name and the relationship to this proposed motor vehicle dealership). Please provide answers on a separate sheet and submit with the application.

Yes No 11. Are you or do you intend on sharing the proposed business location with another licensed motor vehicle dealer?

* If “YES”, give the business name

*A Certificate of Compliance form (BMV 4347) must be submitted with this application.

Yes No 12. To your knowledge, was the proposed business location previously occupied by another licensed motor vehicle dealer?

If “YES”, give the business name, if available

Yes No 13. With the exception of sole proprietors, has the applicant completed the I-9 Employment Eligibility Verification form that is required to be on file with the employer under the Immigration Reform and Control Act of 1986, 8 USC 1324a?

BMV 4321 2/13 [17601163] Page 7 of 8

YOU WILL LOSE YOUR DRIVER LICENSE IF YOU DRIVE WITHOUT INSURANCE OR OTHER

ACCEPTABLE FINANCIAL RESPONSIBILITY COVERAGE

•In Ohio, it is illegal to drive any motor vehicle without insurance or other financial responsibility (FR) coverage.

•It is also illegal for any motor vehicle owner to allow anyone else to drive the owner’s vehicle without FR coverage.

•PROOF OF COVERAGE IS REQUIRED: • Whenever a police officer issues a traffic ticket • At all vehicle inspection stops • Upon traffic court appearances and • Upon random checks by the Registrar of Motor Vehicles.

•ANY DRIVER OR OWNER WHO FAILS TO SHOW PROOF OF INSURANCE OR OTHER COVERAGE WILL: • Lose his or her driver license until requirements are met on first offense, ONE YEAR on second offense and TWO YEARS on additional offenses • Lose his or her license plates and vehicle registration • Pay reinstatement fees of $100.00 for first offense, $300.00 for second offense, $600.00 for third and subsequent offenses • Pay a $50.00 penalty for any failure to surrender his or her driver license, license plates, or registration AND • Be required to maintain special FR coverage (“High-risk” insurance or equivalent) on file with the Bureau of Motor Vehicles (BMV) for THREE or FIVE YEARS.

•ONCE THIS SUSPENSION IS IN EFFECT: Any driver or owner who violates the suspension will have his or her vehicle immobilized and his or her license plates confiscated for at least 30 DAYS first offense and 60 DAYS second offense. For third or subsequent offenses, the vehicle will be forfeited and sold and the person will not be permitted to register any motor vehicle in Ohio for FIVE YEARS.

•IF YOU ARE INVOLVED IN AN ACCIDENT WITHOUT INSURANCE OR OTHER FR COVERAGE: In addition to all the penalties listed above, you may have • A SECURITY SUSPENSION for TWO YEARS or more and • A JUDGMENT SUSPENSION INDEFINITELY (until all damages have been satisfied).

•THESE PENALTIES ARE IN ADDITION TO ANY FINES OR PENALTIES IMPOSED BY A COURT OF LAW.

•WARNING: THESE LAWS DO NOT PREVENT THE POSSIBILITY THAT YOU MAY BE INVOLVED IN AN ACCIDENT WITH A PERSON WHO HAS NO INSURANCE OR OTHER FR COVERAGE.

•WHEN REQUIRED, PROOF OF COVERAGE MAY BE SHOWN BY ANY OF THE FOLLOWING: • AN INSURANCE POLICY showing automobile liability insurance of at least $12,500 bodily injury per person, $25,000 injury two or more persons, and $7,500 property damage • AN INSURANCE IDENTIFICATION CARD (same coverage) • A SURETY BOND OF $30,000 issued by any authorized surety company or insurance company • A BMV BOND SECURED BY REAL ESTATE having equity of at least $60,000 • A BMV CERTIFICATE FOR MONEY OR GOVERNMENT BONDS in the amount of $30,000 on deposit with the Ohio Treasurer of State • A BMV CERTIFICATE OF SELF-INSURANCE, available only to companies or persons who own at least twenty-six motor vehicles.

I affirm that the motor vehicles owned by this business will be insured or have other FR coverage, will not be operated without FR coverage and will not be used as commercial vehicles unless so registered.

I also affirm that all statements in the foregoing application and in any attached sheets are true and correct and that I, as owner, as a partner, an officer, member, or trustee, have authority to sign this application and to make the statements contained herein and have initialed as required.

DATE OF APPLICATION

SIGNATURE (OWNER, PARTNER, PRESIDENT, MEMBER, OR TRUSTEE)

	X
TITLE	PRINTED OR TYPED NAME OF SIGNER

NOTARY:
Subscribed and sworn to before me this			day of	,					in the county of		State of
Ohio.
(SEAL)
My commission expires						X
						SIGNATURE

RETURN THE COMPLETED APPLICATION, PHOTOS,

OTHER SUPPORTING DOCUMENTS AND FEES TO:

Ohio Bureau of Motor Vehicles

Attention: Dealer Licensing Section

P.O. Box 16521

Columbus, Ohio 43216-6521

For Additional Information and Laws

Visit our Web site at www.ohioautodealers.com

BMV 4321 2/13 [17601163] Page 8 of 8